OmniPod Medicare Part D Coverage

I have used the OmniPod since 2009 and love the system. In December, I will need to sign up for Medicare. In talking to Insulet Corporation, I learned that Medicare will cover the OmniPod system under the prescription Part D plan, but that when I apply, I will have to get the Part D carrier to make an exception since OmniPod is not a part of the normal formulary of most companies. I would like to use SilverScript for many reasons, but SilverScript has three plans: Choice, Allure, and Plus. Insulet told me that they have “many patients” who are getting their Pods through SilverScript – having had their exception letters accepted. Great! So I called SilverScript to find out which of the three plans will accept the exception letter to cover the Pods. They refused to give me that information. They said I had to sign up for the plan before they could tell me if the Pods would be covered. That means that if I choose the WRONG plan, I would have to pay about $500 a month from March (when I officially go on Medicare) until October (when I would be eligible to choose a new Part D plan). So my question is this: does anyone using the OmniPod system have SilverScript for coverage? If so, which plan (or plans) will accept the exception letter for coverage? I have to go through Florida for my drug plan, so I can get this covered my Medicare. Thanks to anyone who can help.

Consult your agency on aging. They all have a specialist who can assist you.every are has an agency on aging. Good luck. Nancy50

Thanks for the idea.

Consult with OmniPod to find out which insurance company/plan has included OmniPod in their 2019 formality submitted to Medicare. It is likely that no insurance plan has included OmniPod in the 2019 Medicare formality, as Medicare approved it in Plan D not too long ago.

Most pharmaceutical companies provide discount to Medicare users under certain conditions. You may want to ask them for this or other discount for senior. Keep in mind that the retail price is used for “donut hole” amount calculation. Good luck.

Waynec2, I have talked to the Medicare people at Insulet twice. Both United Health through AARP and Cigna have added the OmniPod to their formulary, so they are both willing to cover it through Part D. No one will cover it through Part B. At least this is better than no coverage at all. The folks at Insulet also told me to choose whatever SilverScript policy I find works the best for my other medications and to get my doctor to write the exemption letter. The lady at Insulet said that “almost all” of the exemption letters get accepted. I will try and hope that I do not have to jump through these hoops each year.

There are many accessible health insurance plans available to take. But choose the one which is best to fulfill your need and requirements. Shop different Medicare Supplement insurance plans from The Health Exchange Agency to help cover some of the costs not covered by Medicare such as deductibles, coinsurance and other medical related coverage. My uncle is also enrolled in this company for health plan.

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Well if that isn’t the most ridiculous thing I’ve ever heard. Geeze. Sorry about these difficulties, SherryAnn. They are ridiculous.

Thank you for your reply, @SandraSegura. Welcome to TuD, it is good to see you posting in the forum.

I have it worked out for now. I can get a 5-pack of Pods through the pharmacy, and they will be covered by SilverScript Allure program as a Part D “drug.” I still have to pay my “portion” of the prescription, but some coverage is better than nothing. No one will budge on the classification. The OmniPod system remains a Part D “drug” under Medicare.

I agree that they are ridiculous, but it is what it is for now.